Predicting Long-term Disease-free Survival After Resection of Pancreatic Ductal Adenocarcinoma
Iris W.J.M. van Goor, Thijs J. Schouten, Daphne N. Verburg, Marc G. Besselink, Bert A. Bonsing, Koop Bosscha, Lodewijk A.A. Brosens, Olivier R. Busch, Geert A. Cirkel, Ronald M. van Dam, Sebastiaan Festen, Bas Groot Koerkamp, Erwin van der Harst, Ignace H. J. T. de Hingh, Martijn Intven, Geert Kazemier, Maartje Los, Gert J. Meijer, Vincent E. de Meijer, Vincent B. Nieuwenhuijs, Daphne Roos, Jennifer M. J. Schreinemakers, Martijn W.J. Stommel, Robert C. Verdonk, Hjalmar C. van Santvoort, Lois A. Daamen, I. Quintus Molenaar, for the Dutch Pancreatic Cancer Group
Abstract
OBJECTIVE: To develop a prediction model for long-term (≥5 years) disease-free survival (DFS) after the resection of pancreatic ductal adenocarcinoma (PDAC). BACKGROUND: Despite high recurrence rates, ~10% of patients have long-term DFS after PDAC resection. A model to predict long-term DFS may aid individualized prognostication and shared decision-making. METHODS: This nationwide cohort study included all consecutive patients who underwent PDAC resection in the Netherlands (2014-2016). The best-performing prognostic model was selected by Cox-proportional hazard analysis and Akaike's Information Criterion, presented by hazard ratios (HRs) with 95% confidence intervals (CIs). Internal validation was performed, and discrimination and calibration indices were assessed. RESULTS: In all, 836 patients with a median follow-up of 67 months (interquartile range 51-79) were analyzed. Long-term DFS was seen in 118 patients (14%). Factors predictive of long-term DFS were low preoperative carbohydrate antigen 19-9 (logarithmic; HR 1.21; 95% CI 1.10-1.32), no vascular resection (HR 1.33; 95% CI 1.12-1.58), T1 or T2 tumor stage (HR 1.52; 95% CI 1.14-2.04, and HR 1.17; 95% CI 0.98-1.39, respectively), well/moderate tumor differentiation (HR 1.44; 95% CI 1.22-1.68), absence of perineural and lymphovascular invasion (HR 1.42; 95% CI 1.11-1.81 and HR 1.14; 95% CI 0.96-1.36, respectively), N0 or N1 nodal status (HR 1.92; 95% CI 1.54-2.40, and HR 1.33; 95% CI 1.11-1.60, respectively), R0 resection margin status (HR 1.25; 95% CI 1.07-1.46), no major complications (HR 1.14; 95% CI 0.97-1.35) and adjuvant chemotherapy (HR 1.74; 95% CI 1.47-2.06). Moderate performance (concordance index 0.68) with adequate calibration (slope 0.99) was achieved. CONCLUSIONS: The developed prediction model, readily available at www.pancreascalculator.com, can be used to estimate the probability of long-term DFS after resection of pancreatic ductal adenocarcinoma.